Does intervening to improve early academic adversity impact later mental health during adolescence? A population-based linked data modelling study in Wales.

objectiveThe UK is facing a child and adolescent mental health crisis. We explored academic adversity recorded in year 6 in relation to diagnosed anxiety or depression in adolescence (ages 13-18). We then modelled the effect of real-world interventions aimed at addressing academic adversity, including Sure Start and universal free school meals combined, on mental health outcomes. METHODS AND ANALYSIS: Our sample consisted of children in the Welsh Secure Anonymised Information Linkage (SAIL) databank that includes individuals born between 1 January 2000 and 31 December 2022. The outcome was a first diagnosis of anxiety or depression between ages 13 and 18 identified through primary care records or hospital admissions. We constructed an adversity score within the school and academic ability domain including attainment, attendance, exclusion and teacher-pupil ratio and used adjusted multivariable logistic regression to examine the relationship with the outcomes. We generated adjusted population attributable fractions (PAFs) to estimate the reduction in outcome risk if adversity scores were reduced. Using combined effect estimates from evaluations of Sure Start and universal free school meals, we calculated the absolute reduction in the outcome risk had children been exposed to both interventions.

resultsAmong adolescents aged 13-18, 2.8% (6620/233 329) of boys and 7.2% (16 034/221 622) of girls had a first diagnosis of anxiety, while 2.7% (6463/236 165) of boys and 6.4% (14 276/224 462) of girls were diagnosed with depression. In fully adjusted models, higher academic adversity scores (across all levels) in year 6 were significantly associated with increased odds of anxiety for both boys and girls. For depression, higher adversity (across all levels) was associated with increased odds among girls, while highest adversity (2+) was associated with depression among boys. PAFs suggested that reducing adversity could lead to modest reductions in the reporting of anxiety and depression, with greater potential impact for boys. Hypothetical exposure to combined early-life interventions (Sure Start and free school meals) resulted in small absolute reductions in anxiety diagnoses (0.6% (11/1816)-1.6% (12/787) for boys; 0.3% (12/3986)-0.5% (11/1080) for girls) and a 0.4% (16/3636) reduction in the reporting of depression diagnoses for girls, with no measurable impact for boys.

conclusionInterventions providing support during childhood may have a modest impact on reducing anxiety in adolescence for boys, and both anxiety and depression for girls.